Fillable Telecommuting Program Application and Work Plan (State University of New York at Oswego)

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Telecommuting Program Application and Work Plan (State University of New York at Oswego)

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The Telecommuting Program Application and Work Plan (State University of New York at Oswego) form is 5 pages long and contains:

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  • 21 check-boxes
  • 70 other fields

Country of origin: US
File type: PDF

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BROWSE STATE UNIVERSITY OF NEW YORK AT OSWEGO FORMS

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Applicant Name and Title:
Page
1 of 5
Telecommuting Program Application
and Work Plan
A. Employee Information (to be completed by the applicant) -Email to next level for review.
Please
check one: New Application Application for Renewal
Name:
Job Title: Bargaining Unit:
Work Desk Phone Number: Work Cell Phone Number:
Supervisor/Manager: Department:
Current Work Schedule (hours/days):
Employee Email Address:
Emergency Contact Information: (voluntary)
Name: Phone Number:
Are you currently serving a probation period? Yes No
B. Equipment
Do you have a state-issued laptop? Yes No Inventory Tag #:
Do you have a personal computer (PC)? Yes No
C. Personal Privacy Protection Law Notification
The information you are providing will be used to determine your eligibility to participate in the
Telecommuting Program. This information will be retained by Human Resources. Failure to provide the
requested information may result in a delay in processing or denial of your application.
It is the responsibility and the intent of the State of New York to fully comply with the provisions of article 6-A
of the Public Officer’s Law, the Personal Privacy Protection Law. The Personal Privacy Law protects you
from the random collection of personal information by state agencies. The law enables you to access and/or
correct information on file which pertains to you. It also regulates disclosure of personal information to
persons authorized by law to have access for official use.
Applicant Name and Title:
Page
2 of 5
D. Telecommuting Work Plan
Rationale for the Telecommuting Agreement:
Telecommuting Location:
Address of Work Location:
Telephone:
Email Address:
Wor
k Schedule:
I will be available to my manager and other key customers during the following times as part of this agreement:
Start Date of Telecommuting Schedule:
End Date of Telecommuting Schedule:
Regular Telecommuting Schedule (Include days/hours you will be working at the telecommuting work
location. All other workdays are presumed to be at the campus):
Applicant Name and Title:
Page
3 of 5
Performance Goals and Work Plan:
Projects/Job Functions to be
performed while telecommuting:
Observable measures that
demonstrate successful progress on
each Project/Job Function:
Contacts/Others
involved in
completion of
project:
Deadline
date:
1.
2.
3.
4.
Applicant Name and Title:
Page
4 of 5
Choose all that apply:
Performance concerns
Duties require physical presence at official work
site
Technology/equipment
limitations
Operational hardship
Task cannot be quantified
and/or evaluated
Other
Provide additional information to
support your decision:
D. Attestation
I have received, read, and will comply with the SUNY Telecommuting Program, my campus
employee handbook, and the following policies if any (to be completed by manager):
By entering your name, you are signing this document and agree to abide by all rules and guidelines.
Employee Name Date
*Email the application to your immediate supervisor/manager for review.
This section should be completed by immediate Supervisor/Manager within 7 days of receipt
Date submitted to immediate Supervisor/Manager (or designee):
I have reviewed the application and the employee:
Meets criteria
Does not meet criteria (if this option is selected, you must complete both boxes below)
By entering your name, you are signing this document.
Supervisor/Manager Name: Date:
Supervisor/Manager Title:
Supervisor/Manager Email Address:
*Supervisor/manager: email application to your division/department head (or designee).
END OF PAGE INTENTIONALLY LEFT BLANK
Applicant Name and Title:
Page
5 of 5
Choose all that apply:
Performance concerns
Duties require physical presence at official work
site
Technology/equipment
limitations
Operational hardship
Task cannot be quantified
and/or evaluated
Other
Provide additional information to
support your decision:
This section should be completed by Division/Department Head within 7 days of receipt
Date submitted to Division/Department Head (or Designee):
I have reviewed the application and the application is:
Approved
Rejected (If this option is selected, you must complete both boxes below)
By entering your name, you are signing this document.
Division/Department Head Name: Date:
Division /Department Head Title:
Division/Department Head Email Address:
This section should be completed by Senior Campus Leader within 7 days of receipt:
Date submitted to Senior Campus Leader (or Designee):
Senior Campus Leader Name: Date:
Senior Campus Leader Title:
This agreement is (circle one): Approved Rejected
If rejected, please justify why:
Distribution:Human Resources
Employee
Supervisor/manager
Please forward the fully approved and completed application to HR at hr@oswego.edu.
August 2021
*Division/Department Head: email application to your Senior Campus Leader.
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Telecommuting Program Application and Work Plan (State University of New York at Oswego)

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Completed 12 August 2021

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